Provider Demographics
NPI:1689614851
Name:CHAN, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 951144
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:614-546-4441
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-234-2970
Practice Address - Fax:614-234-2977
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350580322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD95987Medicare UPIN
OHCH7373071Medicare PIN
OHCH7373061Medicare PIN
OH4224321Medicare PIN